Healthcare Provider Details

I. General information

NPI: 1124565569
Provider Name (Legal Business Name): VALERIE CASTLE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 I 55 N
JACKSON MS
39206-3616
US

IV. Provider business mailing address

5411 I 55 N
JACKSON MS
39206-3616
US

V. Phone/Fax

Practice location:
  • Phone: 601-940-5906
  • Fax:
Mailing address:
  • Phone: 601-940-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2108
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: